Consent Form

Data Protection Act

I do / do not* agree to BASE releasing contact details for our agency to interested parties. (* please delete as appropriate)

Signed:

Name: (PLEASE PRINT)

Name and address of agency: (PLEASE PRINT)

Telephone number:

Fax number:

Internet Details

Name of contact person for BASE contact :

Email address:

Website address:

Would you like a link to your website on the BASE site? YES / NO *

Would you be interested in receiving briefings by email? YES / NO *

(* please delete as appropriate)

Thanks for completing this form. Please return it to us at:

BASE Secretariat
c/o Pluss
Clittaford Road
Southway
Plymouth PL6 6DF